Recent technological changes in neonatal intensive care (NIC) have reduced the mortality rate of very small infants, but a high percentage of these babies may eventually have intellectual impairments or neurological problems. Language and learning complications may affect an even higher percentage with estimates ranging up to 50%. Little information on risks is available regarding the nonmorbid outcome of NIC infants. Attempts at early identification of those infants who will subsequently have language delays have been largely unsuccessful. One of the primary difficulties in establishing appropriate interventions for communicatively disordered infants is the lack of effective and efficient instruments which permit the identification of precursors to communicative problems. Acoustic studies of infant vocalizations provide data reflecting neuromotor, laryngeal and supralaryngeal (dys)function. The P.I.'s quantitative phonetic methods also estimate phonetic contrast between the preverbal and verbal periods permitting the possible description of infants at-risk for communicative disorders. The purpose of the proposed study is to apply such new acoustic and phonetic methods to evaluate communication and developmental disorders in a modern and expanding population of prenatal cocaine exposed, at-risk infants in relationship to nonexposed cohorts. A major objective will be to conduct a developmental follow-up at hospital discharge, and at 6, 12, & 18 months of age of 20 cocaine exposed and 20 matched (for newborn IVH & sex, maternal age, SES, parity, & ethically) non-cocaine exposed infants to determine vocal differences and communication differences as a function of cocaine use. Before hospital discharge we will examine cocaine and non- cocaine groups of at-risk groups as neonates for vocal cry acoustic features and then give follow-up examinations of their vocal, hearing and communication development until 18 months of age. Data to be collected and analyzed using blind procedures in the follow-up period include measures of vocal and auditory function and cognitive, language, and social development, as well as measures of prenatal and home environment. The interaction between physiologic risks and environmental risks is largely unspecified. Because of this, SES will be considered in the current study by using it and related home environment variables as developmental and communication outcome predictors. The results should contribute to the prevention of communication and developmental delays in prenatal cocaine exposed infants by providing an early understanding of their etiology and identification in this new and expanding at risk groups of infants.